Abdominal thrusts, aka the Heimlich maneuver

By Philip Wagenaar, MDThis item appears on page 52 of the November 2017 issue.

Timeline:September 1976. A restaurant in Los Angeles.

Out of the blue, I choked on a piece of meat. I could not breathe. I stood up, my hands clenching my throat. Fortunately, a few seconds later, I could eject the piece of meat from my throat.

I looked around the restaurant. Everybody was staring at me. Nobody had come to help me. Nobody had attempted to use the Heimlich maneuver, which is the first-aid procedure for the treatment of choking caused by foreign objects.

On occasion, it might happen when you are eating that a food morsel, instead of going down your esophagus (gullet), where it is supposed to go, gets stuck in your windpipe, where it will obstruct your breathing. As no air can go to your brain, you cannot speak or breathe and, as a suffocating victim, you need immediate first aid.

The universally recognized sign indicating that a person is choking — the victim clutching his or her own throat — is an involuntary gesture that doesn’t always happen. If you don’t see the “hands around the neck” but want to confirm that the person is choking, quickly look for other signs of oxygen deprivation, such as the inability to talk, trouble breathing, blue skin, blue lips and blue nails (cyanosis) or loss of consciousness.

Don’t spend too much time looking for these signs, however. Remember that your primary goal is to remove any food from the patient’s airway as fast as possible.

To assist a choking victim

There are different techniques to use to assist a choking victim.

1. The American Heart Association suggests the following:

To carry out the Heimlich maneuver on someone else…

• Stand behind the person. Wrap your arms around his or her waist. Tip the person forward slightly.

• Make a fist with one hand and place it slightly above the person’s navel.

• Grasp your fist with your other hand. Press hard into the person’s abdomen with a quick upward thrust, as if trying to lift the person up.

• Perform up to 5 abdominal thrusts. If the blockage still is not dislodged, repeat the cycle.

To perform the Heimlich maneuver on yourself…

• Place the thumb side of your fist slightly above your navel.

• Grasp your fist with your other hand and bend over a hard surface (a countertop or chair will do).

• Press into your upper abdomen with a quick upward thrust.

2. To assist a choking victim, the following is also suggested by the Red Cross.

• Give the person 5 back blows. First, deliver 5 back blows between the person’s shoulder blades with the heel of your hand.

• Next, perform 5 abdominal thrusts (the Heimlich maneuver).

• Alternate between 5 blows and 5 thrusts until the blockage is gone.

Both of the above techniques are all right. (Of course, you can’t give back blows to yourself.)

3. If someone is choking and you’re the only rescuer, perform back blows and abdominal thrusts before calling 911. If another person is available, have that person call for help while you perform first aid. If the choking victim becomes unconscious, perform standard CPR with chest compressions and rescue breaths.

More information

For instructions on how to use the Heimlich maneuver on specialized cases, such as on a pregnant woman, an obese person, an infant younger than age 1 or an unconscious person, or when you can’t reach around the victim, visit the Mayo Clinic webpage mentioned above.

I suggest you take a class to learn the Heimlich maneuver and/or CPR. To do so, go to…